Flexible endoscopic clip-assisted Zenker's diverticulotomy (with videos).

Division of Digestive Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8887, USA.

BACKGROUND: In treating Zenker's diverticulum (ZD), there are potential risks associated with flexible endoscopic diverticulotomy without suturing or stapling. Rigid endoscopic stapler-assisted diverticulotomy has limitations. The septum is usually not completely dissected with either technique. OBJECTIVE: Our purpose was to evaluate the feasibility of flexible endoscopic clip-assisted diverticulotomy (ECD) for complete septum dissection. DESIGN: Case report. SETTING: Academic center. PATIENT: An elderly male with symptomatic residual ZD. INTERVENTIONS: After 1 endoclip (InScope multiclip applier, Ethicon Endo-Surgery) was placed on each side of the cricopharyngeal bar, the septum was easily and completely dissected between these 2 clips down to the bottom of the diverticulum into the esophageal mucosa with a needle-knife. MAIN OUTCOME MEASUREMENT: Symptom resolution and complications. RESULTS: Complete esophageal symptom resolution without complications. LIMITATION: Case report. CONCLUSIONS: ECD is feasible, easy, safe, and effective for complete septum dissection. This is the first reported case of ECD. ECD provides another option in managing ZD with flexible endoscopy.

PMID: 18308312 [PubMed - indexed for MEDLINE]